December 2004
Career Options
Robert F. Priddy
David Nissen Kahn, MD

Many physicians who call career placement companies are seeking to leave the practice of medicine. In fact, the most familiar refrain we hear is, “I’m not sure I want to, but I guess I could work for a big company.” Typically, our response is, “Let’s not discuss what you think you could be doing, but rather let’s find out what you should be doing with your career.”

The best career placement companies endeavor to determine not only what each physician client is good at, but also what career path makes each client happy. After gathering this information, these career placement companies can help create a “best fit” workplace option for the physician.

Finding a Match
Many physician clients of career placement companies should in fact do what they set out to do many years ago: Be physicians. Caring for patients is what they’re best equipped to do and it’s what makes them joyful. The passion in their lives is delivering the best medical care possible to interested, appreciative patients in a happy team environment.

In our business over the past several years, we have seen physicians make significant changes in how they practice medicine. One general surgeon was typical of the physicians we saw. Frustrated by the administrative hassles and rising malpractice premiums that are common today, he decided to open an endoscopy center that allowed him to control his practice style and hours and decrease his malpractice exposure at the same time. Now he runs his own practice, instead of the practice running him.

For some physicians, making changes in their practice involves first identifying what needs to be changed. Because the changes they are considering are so significant, they often begin to think about going into a new line of work that is outside of patient care. The three physicians we profile in this article were doing just that: thinking of leaving the practice of medicine. But after identifying and making the changes that were needed, each one is continuing in medicine and is much more satisfied and fulfilled by doing so. All three have reignited the passion they had when they entered medicine, showing that positive change is possible and quite achievable despite the circumstances.

Back to Basics
Many physicians struggling under the constraints of managed care have forgotten that patient care is their passion. Some may wonder if there even are any appreciative patients or if a happy, contented care team environment even exists in this cost-conscious, efficiency-focused health care world. Finding the perfect practice has never been easy, and it is particularly difficult today. However, as experts in physician careers, we have seen that practicing medicine need not be as difficult as it now is for many physicians.

The first step in this career assessment involves identifying the variables linked to the most significant problems in a medical practice. Although individual situations vary, the following variables would apply to most practices:
• Patients
• Staff
• Location
• Specialty
• Partners
• Income

As the following anecdotes show, it is possible to change any one of these variables.

Making Choices
David Steiner, MD, PhD, is an obstetrician/gynecologist in Chicago. When we met him, he was in the second practice of his three-year career. Although he enjoyed the intellectual challenge of medicine, the relationships he had with his patients, staff, and partners were not rewarding. He found the focus to be too heavy on production, believed he was not supported in his practice growth, and had noncompliant patients. Like many of the physicians we see regularly, he believed he needed to leave the practice of medicine, possibly for a career in community health, his doctoral field.

Based on the fundamental principle that any of the variables can be changed, we made a plan for him to leave his current practice. In making arrangements for him to leave, we suggested that he identify the areas of work that he most wanted and needed, as well as the areas that he wanted to avoid in any new setting. Once he had identified those areas, he could look knowledgeably and productively for opportunities in clinical medicine and in community health that would not reproduce the frictions he had experienced in the past.

Working closely with Steiner and his lawyer, we crafted an acceptable separation agreement, connected him with a number of physician recruiters, and suggested he call other professionals with whom he had worked in the past who could help him find his next career opportunity. As a result of these suggestions, he began calling people to find opportunities in ob-gyn practices and in community health settings. By the end of the second month of his job hunt, mostly through directed networking, Steiner was entertaining two intriguing opportunities: one in a thriving practice near Chicago, the other in a public health position that required both his MD and PhD degrees.

As Steiner considered both options, he realized that what he wanted and needed was to continue working as a practicing physician. By identifying the variables in his career that had been affecting his happiness, job-placement testing and assessments had revealed a need for deliberate thinking and action, for strong interpersonal relationships, and the ability to direct his own work activities. His work environment was demanding fast action and decision-making, offered an absence of close relationships with staff and colleagues and the focus on his production left him feeling controlled. Steiner learned that understanding these issues gave him the power to change them so that they worked for him not against him.

Not surprisingly, Steiner found he could stay in clinical practice, where he feels he belongs. Today he has both an active clinical practice with an established patient base and is involved in issues of health planning and developing programs to address the health needs of the clinic’s patients.

Improving Conditions
Steiner had to leave his former practice to find the right career match, but we have found that it is possible for many dissatisfied physicians to remain in their current situations if they are willing to make the necessary changes to improve their working conditions.

Corinne Dawson-Taylor, MD, was like many physicians who say that while their incomes are acceptable, they have to work too hard and too long for it. She felt that her income didn’t match the effort she was expending for it and therefore wanted to leave her practice.

To resolve Dawson-Taylor’s dilemma, we examined her books and found that her gross charges were in the 95th percentile. This level
was higher than we would expect in her situation, a pediatrics
practice in Denver with a high percentage of Medicaid patients. At
the same time, what her staff collected was below the 50th percentile. Dawson-Taylor’s frustration was appropriate: She was working harder and getting paid less than her colleagues.

After examining her books, we found that her billing and collection processes were inefficient. We helped her find the holes in her systems and recommended more rigorous processes and procedures to plug the leaks. Within two months, she had collected most of her “old dollars,” and her collection rate was much more appropriate to her effort. She added $250,000 to her annual income. As a result of these efforts, a good clinical doctor decided to continue caring for sick people.

Before undertaking these efforts, Dawson-Taylor hadn’t disliked practicing medicine—even in the current managed care environment—but she hated running on a treadmill. When we examined the variables together, she found that the principle is right: Any of them can be changed.

Facing Trials
Making a number of significant changes in one’s practice may seem daunting at first, but once the process has begun, the effort—and the corresponding results—can be highly rewarding. This was the lesson Stacy Childs, MD, learned, after 25 years of practice as a urologist in Cheyenne, Wyo.

By almost any measure, Childs was successful. Yet, over the previous two years, he had lost his passion for practicing medicine. Clinical research, an exciting and lucrative part of his urology practice for 24 years, had become less rewarding because reimbursement had declined while the paperwork requirements were increasing. What’s more, although he was honored to be appointed to the Wyoming Governor’s Health Care Commission, he found the appointment to be time consuming and frustrating.

“It was also an eye-opener to the myriad problems in the health care system, not only in Wyoming but in all states,” Childs says of his experience on the commission. “I became more and more disappointed in the lack of access to care for the uninsured and underinsured. And, I realized that all doctors are constantly in the crosshairs of trial attorneys—just waiting for an honest mistake to be called negligence.”

Renewed Interest
Childs’ exposure to health policy piqued his interest in medical liability problems. He took courses in medical malpractice and the law and began to serve as an expert witness in court cases. Soon, he became so involved that he started teaching seminars on malpractice and on testifying skills. “I thought my new career was born,” he says.

While the work was challenging, practicing medicine while building a seminar business was extremely stressful. Being uncertain about how to proceed, Childs consulted a career specialist and learned that making a career change that would make his life less stressful was not only possible, but inevitable, he says. Through his work with a career consultant, Childs met a urologist in Steamboat Springs, Colo., who invited Childs to join his practice. Although continuing to practice medicine had not been his first choice, Childs reasoned that joining the urologist’s practice would reduce his stress and provide cash flow while he started his seminar business. Also, the practice was convenient to his new home in Steamboat Springs, where he and his wife planned to retire.

In his new practice, Childs went from seeing 40 patients a day to seeing just 15, affording him more time for his other interests, he says. “In my new practice, I have been able to spend as much as an hour with difficult patients,” he comments. “Some days I can have breakfast or lunch with my wife, and start work an hour later than in the past. And, the big plus: My new partner’s office manager has trimmed overhead to about 60% of that of my former practice; my take-home pay has gone up rather than down.”

Like many physicians, Childs had assumed that changing his work situation would be difficult if not impossible. “Although my life was filled with stress and hard work, I assumed that I had to change occupations rather than locations,” Childs says. “I am now a urologist in a full-time practice that feels like part time. I feel that I can continue in this location and role until retirement age. Then, I’ll revisit a career change into the seminar business.” Meanwhile, Childs says that he will have the time and cash flow to continue building his seminar business.

Managing Change
As these three physicians learned, making changes can be a challenge. But doing nothing might have been a mistake. Change can hurt when it’s done to you; it’s less painful, and perhaps even pleasant, when you make the changes.

Physicians who make changes in their careers find that they control
all of the variables. Physicians who don’t make changes when factors beyond their control are affecting them negatively soon learn that these factors could result in changes they may not like.

If practicing medicine seems like an obstacle not a challenge, if you feel threatened, unhappy, or frustrated in your career, and if you like practicing medicine but hate the way you have to do it, then you are experiencing some of the symptoms that these three physicians once experienced.

As any physician knows, patients experiencing certain symptoms recognize that something is wrong, and the more intense the symptoms, usually the more threatening the disease. It’s foolish and risky for them to ignore their symptoms or delay finding out what they mean; the sensible thing to do is to seek treatment. Likewise for physicians who are unhappy in their career: Consulting an expert who can offer good advice about what to do is often the most sensible thing to do.

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